Check out the counters

It took three guys three hours, but we have something that actually looks like a kitchen. K is planning on hooking up the sink tomorrow and then I believe the house will probably be struck by lightening or something because we will finally be back to a usable kitchen.

Code

Yesterday, despite being on a transfer truck, I ended up helping on a cardiac arrest. Our company has a bariatric stretcher with a hydraulic lift system (aka "fatty stretcher"), but in order to use it on an emergency call, you have to call back and have a transfer truck bring it to you. In this case, the call was for elbow pain due to a fall. So no great hurry, but the crew was going to need help to move the >500lb patient.

Patient heads out to us and we get him into the ambulance. My partner and I are heading back to our ambulance when the crew calls us back. Patient is having difficulty breathing. Then patient is not breathing and pulseless. The bariatric stretcher takes up nearly all available floor space when loaded into the ambulance and now there are 2 911 crew members, their student, and 2 transfer truck crew members trying to perform CPR and ACLS on this patient. Not an easy task.

Unfortunately, the patient didn't make it. This is the first call I've done where I met the patient while he was walking and talking and actually watched him die. I have to say it is a lot easier to work on a patient who was dead when you got there than a patient who dies in front of you.

Edited 21Feb: Thanks to Ellie for pointing out ManchMedic's post on this call. It was informative for me to read more of what happened before we got there. I was wondering why some things went down the way they did, and I tend to assume that medics make informed decisions and try not to "back-seat" "hind-sight" "monday-morning quarterback" on calls, so I don't always ask questions even though ManchMedic would be happy to answer them.

Tired of being sick

Why does every cold have to turn into something miserable? I was feeling pretty darn good about not being sick lately, which was obviously the cue for the local virus to hop on board and change that. Lately, colds have been dropping down into respiratory infections for me, with a lovely hacking cough that won't quit. This one likes sinuses better. I spend all day feeling like someone is standing on my head. No matter how much snot I push out, the pressure doesn't stop. Decongestant won't touch it, somehow it is beyond the reach of mere pills. Stupid virus.

Follow up

One of the frustrations in EMS is that you frequently don't know the end of the story. You drop your patients at the ER and that is the last you know about them. Since our city only has two hospitals, sometimes you can follow up on your patients a little more, and being the main transfer service means that sometimes you hear more from your colleagues.

So here's some updates on a few patients I've written about recently:

• Patient our student revived was still alive in ICU 2 weeks later. Hospital did eventually find some family members so hopefully they were able to make good decisions for him.

• The Asian and I were mulling whether a Catholic nun could disconnect her sister from life support without committing a mortal sin when we saw the patient's obituary in the paper. She died within 24 hours of arriving at the hospital. My best guess would be that nobody had to make a decision like that, the patient probably went into cardiac arrest again and this time they were able to honor her wishes for DNR.


• Car accident patient who got us on the news had his legs put back together by orthopedics. Still some danger he might lose the worst one if infection sets in but a pretty darn good outcome for being crushed in a box truck.
  

I'm hoping that my string of bad luck has finally run out. I've had two 911 shifts in a row without a dead person or someone seriously circling the drain. My run of luck has been so bad that The Asian has more IOs with the new EZ-IO than anyone else in the company. He has seven and the next nearest medic has three. This streak started in September with a string of pediatric patients and has been all over the map since and I would not be sorry to work a bunch of drunks and psychiatric patients for a while.

TV

So how do I, as an ambulance worker, end up on the evening news? The two most recent cases were a car accident where one patient was severely injured and trapped in the vehicle for an extended period of time (giving the news crews time to get there) and a fire that sounded bigger than it was where the news crew happened to be in the right (or wrong) place at the appropriate time. For whatever reason, our local news LOVES to have footage of EMS or fire departments in action. Maybe it is the sense of importance and tragedy, but I tend to think it is because they don't show the patients and they want to have something interesting which makes the whole event seem exciting. Mostly, we avoid the cameras by being as quick to get the patients off scene as possible. No faster than is appropriate for the patient, but hopefully faster than the cameras show up.

The crews at my station hate being on the news. Firstly, it makes everybody harass you because they never fail to use that 3 seconds of footage where you scratched your butt or stood there looking stunned and ridiculous. Secondly, it gives your supervisors and higher management the chance to see you on scene in a way you may not have been expecting. Not a big deal for me as I wear my ugly neon green reflective coat and non-latex gloves all the time and I try to abide by safety regulations, but there are always folks who assume that nobody is going to see them on scene and that they will get away with doing something they shouldn't be doing. Seeing yourself on the nightly news quickly cures you of that illusion. Heck, in a state as small as NH, just talking to people should cure you of that illusion because there is always somebody around who saw you at XYZ place or with Mrs. So-and-so on your stretcher and wants to know all the dirty details.

Life

After running two pregnancy calls in two days where it looked very likely that The Asian was going to be cleaning and warming newborns, I was prepared for our truck to be ushering new life into the world. I was not prepared for what we got instead.

Dispatch was for difficulty breathing, elderly female. At 0150, this is usually a serious call because most folks aren't doing anything strenuous at that hour and if a patient still having difficulty breathing, it is bad news. FD meets us out front, directing us to the side door and helping grab the stretcher, indicated we wouldn't need anything else. As I walk in, I see a FF taking a blood pressure who stops when he sees me and shakes his head no. Misinterpreting, I assume this means he wasn't able to get a good reading. And I check for a radial pulse, none. The second FF says, "I didn't get a pulse." So I check a carotid pulse, none. FF again, "I didn't get a carotid pulse either."

At this point, I'm worried about the patient but also substantially confused as to why the FFs are standing there just staring at her. While trying to find pulses, I was watching for breathing and not seeing any. Hmm, no pulse + no breathing = dead, at least the last time I took a class. Second FF pipes up again, "She was moaning and gurgling when we got here, then stopped." Crap. I can hear The Asian in the other room talking to family about medical history and patient's wishes, so I poke my head out to find out if we're going to try CPR and ACLS or if the patient has a DNR at hand. His quick decision is that there isn't enough certainty by family nor documentation to support not resuscitating the patient. He's back to the truck for our gear, I'm back in the room suddenly in charge of a cardiac arrest, an unusual reversal of roles.

I'm trying to get the FFs moving toward CPR and the AED, but (in all seriousness) it is a difficult mental transition from "we're going to put the patient on the stretcher" to "find the BVM, hook up the defib pads". After all, I walked in to find a dead patient, they walked in to find a barely alive one. They don't really get moving until I whip out the shears and cut her nightgown down the middle and start tossing their oxygen bag looking for a BVM. No shock advised by the AED gets us going into compressions, then onto the backboard and out to a bigger room so The Asian can intubate.

After the first round of medications during the less than 1 mile trip to the hospital, she now has a pulse. On her own. She still isn't breathing well, but her heart is up and running again. This is the event I wasn't prepared for. A patient with questionable DNR status actually being resuscitated. And her sister is also a Sister, who is kind and understanding, but pretty intimidating in her head covering in the waiting room of a religious hospital. We didn't bring new life into the world, but somehow we managed to hang on to an older one which may not really want to be here.

Downside

EMS routinely puts patients on long spinal immobilization boards to prevent further spinal injury. And when we do, the goal is complete immobilization, no movement at all. Which is great, until they need to vomit.

Standard protocol for people vomiting when immobilized is to roll them on their side. But once you've secured the backboard to the stretcher, there isn't enough slack in the seat belts to easily roll the patient. If you're in the ambulance, you can reach over and open the belts and roll the board. But if you're walking the stretcher into the hospital room and then the patient starts to vomit, you aren't really in a good position to loosen everything. And if you're at the head of the stretcher, you are in the wrong spot.

Speaking from experience, this results in a vomit-covered EMT. The only entertaining part was that this guy had such force to his vomit that it was everywhere. I guess in the end it was good that I was the one covered in the vomit because I was the only one not dry-heaving or actually vomiting at the sight/smell. Glad I could be of service.

p.s. my camera just came back, good as new, so the pics of the kitchen are better now.

Non-writing holiday

Okay, so I haven't been posting. Honestly, we've been working on the kitchen and I've been rocking out to Guitar Hero. I got kinda bummed about my camera, so I haven't been keeping up with photos of all the kitchen work either. K and I put together some camera phone pictures so we could post something at least, check out the recent work on the right.

Today we worked 6 hours on the kitchen and got a bunch of the backerboard for the ceramic tile done, should have the rest finished tomorrow. Tile itself will probably have to wait until Wednesday when we're both around because I don't know how to run the wet saw and it is on loan from someone.

Work has been going okay, there's been a lot of little annoying stuff going on with management, but nothing I feel reasonable writing about. The Asian and I made the evening news twice in three days (damn, two station lunches!), once for a doozy of a MVA and once when we hauled off the only smoke inhalation patient from a fire.

Living in NH during a campaign season is extremely annoying. Large mobs of political supporters on many corners, freezing, shouting, and swinging signs. Thankfully, no ambulance calls for political-related assaults or injuries yet.

I'll try to be better about posting. Biochemistry class starts on 1/23 and yes, the plan is to be done with the kitchen by then so I have time to study. Later!